Term
| Upper Quadrant of the hand consists of... |
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Definition
Scapula, shoulder, arm, hand
1/3 all acute injuries in US
63% of 90,000 repetitive work injuries |
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Term
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Definition
disruption in blood supply. Nerve is
in tact. Usually compression. Full recovery from
Days to 6-8 weeks |
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Term
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Definition
sheath is intact. Usually by compresion
Or a stretch. Pull axon apart but sheath intact.
Sensory & motor disruption. Grow 1 mm. |
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Term
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Definition
complete disruption of the nerve
And the sheath. Disruption of both sensory and
motor. Need surgery. |
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Term
Nerve Response to Injury
Phase 1 |
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Definition
Wallerian degeneration distal to injury
Disintegration of axon
Breakdown of myelin sheath
Schwann sheath and endoneurial tubes remain but may shrink or collapse
End receptors can degenerate |
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Term
Nerve Response to Injury
Phase 2 |
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Definition
(3-4 weeks)
Neural regeneration with sprouting of axons
Axon must cross injury site & enter endoneurial tube
1-2 mm / day |
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Term
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Definition
Maximize Daily Function
Prevent overstretching
Prevent muscle imbalance
Prevent contractures
Sensory & motor retraining |
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Term
| Sensory nerve recovery from 1st to last |
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Definition
Pain & temperature
Vibration
Moving touch
Constant touch |
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Term
| What phase after nerve repair would you do ROM and sensory retraining? |
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Definition
| Post Immobilization/Recovery Phase |
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Term
| In acute phase for nerve repair, what main things do you want to do? |
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Definition
Protect healing nerve and/or surgical intervention
Immobilization (3-4 weeks)
Edema & wound care
Prevent joint contracture
Splinting
Prevent further injury
Sensory precautions |
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Term
| What are some Radial Nerve Deficits? |
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Definition
Wrist extension
Finger extension
Thumb abduction
Thumb extension
Supination
Elbow extension
Sensation—dorsal—usually not a functional problem |
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Term
| Treatment for ulnar nerve would include |
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Definition
Conservative
Padded handles
Edema control
Avoid repetitive or prolonged elbow flexion
Splints
Elbow extension
Claw hand- higher level at ulnar, fdp are not
working. Closer to wrist, fdp’s over compensate.
Cubital- splinting elbow |
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Term
| Median Nerve: “Eye”of the Hand Major Deficits that would occur |
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Definition
Intrinsics
Thumb Opponens, FPB, APB
Lumbricales (2, 3)
Extrinsics
FDS
FDP (2nd and 3rd)
Pronator Teres
FPL
FCR
Loss sensation palmar/radial hand
Wrist flexion
Pronation
Ape Hand- usually rare |
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Term
Stage I: Inflammatory phase
of Wound Healing |
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Definition
days 1-10
area red, warm, swollen
immobilization to rest injured or surgically repaired tissues
splints
motion begun too early will increase and prolong inflammation
inflammation normal, but should be minimized
modalities |
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Term
| Stage 2: Proliferative (reparative) phase of Wound Healing |
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Definition
Day 3-21
less red, warm, and swollen
wound healing, new tissues laid down
one wound-one scar
Low stress ROM, tendon gliding
Important that we provide structure. Keeping things moving. Preventing contractures. |
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Term
| Stage 3: Maturation phase (restorative) of Wound healing |
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Definition
21 days –18 months (up to 2 years)
permanent tissues laid down
tissues fix, shrink, remodel
if scar not under stress will lay down tissues randomly
pressure garments & splints
keloid or hypertrophic scarring
exercise to return to normal function
Therapist goal to return to function without causing exaggerated inflammatory response |
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Term
| How do we provide a nonadherent scar? |
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Definition
tendon gliding exercises
soft tissue massage
ROM, strtc |
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Term
| How do we provide a supple (flat) scar? |
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Definition
pressure
massage
ROM
modalities |
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Term
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Definition
Thickening of deep facia in palm
Leads to flexion contracture of finger(s)
Cause unknown
Viking ancestry
Progressive
Surgery
Can’t stop it. Can prolong it. |
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Term
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Definition
Remove fascia
Z stitched wound
Tend to do it again after surgery. Surgeons tend not to want to do it unless it affects their hygiene.
For Dupuytren’s Contractures |
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Term
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Definition
Remove fascia & overlying skin
Skin graft from groin
for Dupuytren’s Contracture |
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Term
| Open Palm Technique for Dupuytren’s Contracture |
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Definition
Mc Cash Technique
Healing by secondary intention
3-5 weeks for closure
Decreases flexion force of skin closure
Allows extension of digits
Post op dressing/splint
Whirlpool if open palm technique
Wound care
Scar Management
Edema control
ROM exercise
Progress to Functional Activities/Strengthening |
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